Membership Details Form * ONE FORM TO BE COMPLETED PER MEMBER Due to Health and Safety, and legislation, your membership is void, irrespective of payment of subscription, if you have not completed a membership form. ALL members of 18 years old and over, irrespective of membership type, MUST complete a membership details form. For ALL members under 18 years old the form can be completed by the ‘minor’ and signed by the guardian, or completed in full by the guardian. Type of Membership*SingleCoupleFamilyTemporaryFull Name* First Last Full Name (Associated Member) if applicable First Last Email Address for Associated Member (if different from yours) Other Family Members Full Names (and age if under 18 years old)For minors: Guardian contact name and telephone number?Passport number and issuing country OR NIE number* Year of birth* Email* Enter Email Confirm Email Mobile Phone Number (format: +country code, space, number)*Please don't forget to add the country code and number! ie: +34 666 666 666 or +44 7 777 77 7777Residential Address* City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Normal Town of Residence when in Spain* City Emergency Contact Details:* First Last Mobile Phone Number for Emergency Contact (format: country code, space, number)*Are you a boat owner? Please select*NoSailingMotorIf boat owner: builder, model, name & where moored. Boating experience. Please select*NoneBeginnerGoodExperiencedDo you have any national skippers license? Please selectNoYesLicense country, issuing authority and level? * DISCLAIMER - Costa Blanca Yacht Association - updated on 22nd May 2020. All members must sign this disclaimer before taking part in any CBYA organised activities. DECLARACIÓN JURADAYo,* Como socio y asistente de las excursiones, actividades náuticas, recreativas y asociativas de la ASOCIACIÓN DE AMIGOS DEL YATE, COSTA BLANCA (Asociación Costa Blanca de Yachting) con mi aceptación de estos términos y condiciones, acepto bajo mi sola responsabilidad participar en tales actividades y cumplir las normas impuestas por las autoridades competentes, eximiendo de toda responsabilidad esa asociación que reconozco que desempeña una función meramente de coordinación y sin ánimo de lucro. También acepto contratar una cobertura de seguro de terceros adecuada antes de participar en cualquier actividad de navegación de CBYA. Términos especiales de coronavirus: dado que todavía existen riesgos de salud no cuantificables de COVID-19, cada participante acepta que está participando en las actividades de la ASOCIACIÓN DE AMIGOS DEL YATE, COSTA BLANCA bajo su propio riesgo, y que la ASOCIACIÓN DE AMIGOS DEL YATE, COSTA BLANCA BLANCA por este medio se exime de cualquier responsabilidad financiera por cualquiera, y todos, tipos de enfermedades virales transmisibles, incluyendo COVID-19 o coronavirus, y / o muerte, a cualquiera que participe, o a aquellos dichos participantes puedan infectar posteriormente. Translation for guidance only: I, Mr/Mrs/Mr/Dr. ……………………, with Passport ………………………….. or NIE………………………., as a member and participant in the excursions, nautical, recreational and associated activities of the ASOCIACIÓN DE AMIGOS DEL YATE, (Costa Blanca Yacht Association) with my acceptance of these terms and conditions, I accept under my sole responsibility to participate in such activities and to comply with the rules and restrictions imposed by the competent authorities, discharging them from all responsibility. I recognize that the association performs a function of merely coordination and non-profit making and I exempt the association, which I recognise, from all responsibility. I also agree to purchase third-party insurance cover prior to participating in any CBYA organised activity – boating, social or otherwise. Special coronavirus terms: As there are still unquantifiable COVID-19 health risks, each and every member agrees that they are participating in CBYA activities fully at their own risk, and that the CBYA hereby absolves itself of any financial liability for any, and all, kinds of transmittable viral illness, including COVID-19 or coronavirus, and or death, to anyone participating, or to those who such participants may subsequently infect. Disclaimer Terms Acceptance* I confirm my acceptance of the above disclaimer Terms and Conditions Acceptance* I confirm my acceptance of the CBYA Terms and Conditions Personal Data Agreement acceptance* I confirm my acceptance of the disclaimer below. I agree that the CBYA can hold my personal data in order to send me relevant information about club activities and to carry out the administration and promotion of the club which may include media materials for the club website and Facebook pages. I may at any time exercise my right to modify my personal data by updating this form and/or writing an email to info@cbya.org. EmailThis field is for validation purposes and should be left unchanged. Δ